The faculty of the University of Pittsburgh School of Medicine Departments of Gynecology, Urology, Geriatric Medicine, Gastroenterology and Colon and Rectal Surgery have collaborated to form the UPMC Center for Continence and Pelvic Floor Disorders. Our health care system with over 25 hospitals and outpatients facilities is an outstanding resource for research subject recruitment. Our proven ability to hold leadership positions in the NIH sponsored multicenter surgical trials and to perform a large number of reconstructive pelvic surgeries per year make us a valuable contributor to the Clinical Trials Network for Female Pelvic Floor Disorders. We propose a study protocol assessing two commonly performed reconstructive approaches to posthysterectomy pelvic organ prolapse PH-POP: the transabdominal abdominal sacral colpopexy with paravaginal defect repair and Burch vs. the transvaginal sacrospinous ligament suspension of the vaginal apex with colporrhaphies and sling. Surgical success will be determined by a satisfactory and sustained support of the prolapsing vagina and pelvic visceral function. This proposed randomized trial with three year follow-up will 1) assess the short and long-term outcomes of the two approaches, 2) determine specific patient characteristics that predispose patients to surgical failure, 3) assess the components of an optimal cost effective preoperative workup. In addition, we will study the impact of adjuvant Pelvic Floor Muscle Exercises on postoperative support and continence, improvement in quality of life and patient satisfaction with the surgical procedure. This data will yield valuable clinical information and will help address the regional and specialty variation in the evaluation and treatment of women with PH-POP. We are committed to adhering to the final protocol of the network. Our investigators have unique expertise in assessment of bladder dysfunction and pelvic floor physical therapy. The surgical team is proficient in both surgical approaches and comfortable with the concept of a randomized surgical trial.